A University of Pittsburgh researcher is launching a four-year study of New York’s sepsis regulations to see what worked and what didn’t in the state’s fight against one of health care’s biggest killers.

Research has shown that speeding up sepsis treatment, which New York’s law accomplished, reduces deaths from the condition . The new study will examine the law more broadly, probing whether it might have had unintended negative consequences.

“Just because the protocol is good doesn’t mean that a regulatory-based effort to force hospitals to adopt these protocols led to better outcomes,” said Dr. Jeremy Kahn, a Pitt professor of critical care medicine and health policy and management who is heading the $1.5 million study.

New York required hospitals to adopt time-based sepsis protocols in 2013 after a 12-year-old boy, Rory Staunton, died from the condition after cutting his arm in a gym class a year earlier. The condition, in which the body’s immune system overreacts to infection, contributes to as many as half of all hospital deaths, according to the National Institutes of Health.

Sepsis has been likened to heart attacks and strokes, which killed many more patients before evidence-based treatment protocols were adopted. Hospitals in most states aren’t required to do anything specific to treat the condition, although many have voluntarily adopted protocols. Pennsylvania Health Department officials have said they plan to launch a two-year process this fall to incorporate sepsis protocols in the state’s hospital regulations.

New York’s protocols include taking blood cultures to guide diagnosis and treatment, analyzing lactate levels that can signify septic shock and administering fluids and antibiotics.

Kahn said the protocols raise concerns over two primary dangers: overuse of antibiotics and overuse of fluids.

The study of New York’s three-hour protocols found that administering fluids didn’t appear to improve outcomes, and too much fluid can lead to harm, Kahn said. Antibiotics, while a critical part of sepsis treatment, can also harm patients by killing good bacteria in the gut and creating a more welcoming environment for a deadly infection known as C-diff.

The new study, funded by the federal Agency for Healthcare Research and Quality, will examine complications, length of hospital stays, costs and other elements of the protocols, Kahn said. The study will compare sepsis treatment outcomes in New York to outcomes in Pennsylvania, Massachusetts, Washington and Florida, he said — states with similar numbers and types of hospitals.

“The hope would be to help policymakers in other states, specifically in Pennsylvania, as they design these regulations,” he said.

He expects bigger hospitals with more resources will have better sepsis outcomes than smaller rural hospitals. Another factor that might influence outcomes is whether hospitals have a designated sepsis specialist who influences how hospitals approach the condition.

Researchers plan to study the effects of sepsis policies for the first two years — delivering early results to Harrisburg before the planned update to hospital regulations — and to spend another two years interviewing doctors and health care specialists to gather more detail about how the protocols work.

“We can’t stand by as hundreds of thousands of Americans are dying each year of sepsis,” Kahn said. “But the question is, can we craft those policies; can the policy response to sepsis be evidence-based?”

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Join us in our dedicated fight against C. diff. and help us continue our mission of educating, and advocating for C. difficile infection prevention, treatments, and environmental safety and saving lives worldwide

The scientific evidence has clearly established that in the hospital environment, microorganisms such as Clostridium difficile (C.diff), Methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteriaceae (CRE) are responsible for the infections that kill nearly 300

people in the U.S. every day.

Xenex Disinfection Services’ LightStrike™ Robot with pulsed xenon ultraviolet-C (UV-C) light technology is a proven solution that quickly destroys deadly viruses, bacteria and spores before they pose a threat to patients and healthcare workers. LightStrike Robots help healthcare facilities reduce their HAI rates by destroying the microscopic germs that may be missed during the manual cleaning process. Xenex robots use pulsed xenon, a noble gas, to create Full Spectrum™, high intensity UV light that quickly destroys infectious germs in less than five minutes. Hospitals using Xenex devices have published clinical outcome studies in peer-reviewed journals showing 50-100 percent reductions in C.diff, MRSA and Surgical Site Infection rates when those hospitals used LightStrike Robots to disinfect rooms.

LightStrike Germ-Zapping Robots™ to quickly disinfect mobile equipment just as effectively as they disinfect rooms within their facility. Pathogens like C.diff, Acinetobacter baumannii, MRSA and Vancomycin-Resistant Enterococci (VRE) can travel throughout a healthcare facility on mobile equipment.

To address this gap in the infection control process, Xenex recently partnered with an industry leader in containment units, Mintie Technologies, Inc., to create the LightStrike Disinfection Pod.

Designed to quickly disinfect reusable mobile equipment such as isolettes, ventilators, pressure monitors, wheelchairs and workstations, the

LightStrike Disinfection Pod enables the power of the LightStrike Robot’s intense, germicidal light to be used anywhere in a facility.

The Pod is collapsible, mobile and can be positioned in a hospital hallway or other areas without disrupting or impeding daily workflow. Its proprietary design integrates reflective interior fabric ensuring 360 degrees of UV light coverage over difficult-to-clean equipment including anesthesia carts, ventilators, and mobile imaging machines.

To access and read the article in its entirety please click on the link below:

To read the article in its entirety please click on the following link:

First, pharmacists should lead by example on patient care rounds by always wearing personal protective equipment (including gloves) when entering a room and washing their hands after leaving a room. You know how hand sanitizers claim to kill 99% of germs?

With CDI, welcome to the 1%. It takes good old-fashioned soap and water to remove CDI spores for your skin and prevent you from passing the pathogen to a colleague or patient.

That’s the crazy (or is it sad?) thing about CDI – we cause it with antibiotics, and we spread it amongst each other.

It is important for infection control specialists and antimicrobial stewardship (AMS) teams to work together to decrease CDI rates.

Pharmacists are pivotal members of AMS teams, but even those without a formal role in AMS can (and should) consider all medication-related problems surrounding CDI.

They can recommend appropriate treatment for CDI, leverage their knowledge of medications to help prevent CDI primary infection and recurrence, and think beyond CDI in patients presenting with diarrhea by considering non-medication and medication-related causes.

This peer-reviewed blog post only highlights five of the many interventions pharmacists can make to improve patient care. There is an abundance of other issues surrounding CDI that are not addressed below.

Notably, the role of probiotics for primary and secondary prevention and the role of fidaxomicin and/or fecal transplantation in a CDI treatment algorithm will be saved for another day.

This post also does not address the new FDA-approved monoclonal antibody, bezlotoxumab, which works by binding and neutralizing CDI toxin B. This novel medication demonstrated promising results in phase 3 trials and was associated with a significantly lower CDI recurrence rate than placebo. However, this drug cashes in around $5,000 per dose for a 70 kg patient (without a non-industry sponsored cost-effectiveness analysis in sight). The role in therapy for bezlotoxumab will be an exciting conversation in the ID community this year, so stay tuned!

In the meantime, here are five medication-related interventions that are easy to learn and easy to implement in order for pharmacists to make a huge difference for patients with CDI.

I recently attended a conference where a speaker presenting on CDI asked the audience this question: “Would you give your mom metronidazole?” This resonated with me as I realized the answer was… probably not.

The 2010 Infectious Diseases Society of America (IDSA) guidelines for CDI in adults recommend the use of metronidazole for mild-to-moderate disease and oral vancomycin for severe disease.

Patients should be treated for 10-14 days regardless of disease severity [3]. For patients who experience a first recurrence, it is recommended to treat based on severity of illness, regardless of the previous therapy the patient received. If a patient experiences a second CDI recurrence, the guidelines recommend avoiding metronidazole not for efficacy concerns, but for drug toxicity and safety concerns associated with prolonged use.

The problem with these recommendations is that CDI severity varies widely and there is no universally accepted determinant of “severe” disease. Additionally, enhanced data on phenotypic and genotypic resistance mechanisms in C. difficile noting reduced susceptibility to metronidazole and pharmacokinetic data explaining the poor fecal concentrations of metronidazole leave us questioning if there is any patient population for whom metronidazole is appropriate empiric therapy.

Historically, the decision to use metronidazole over vancomycin has been driven by cost (metronidazole is much cheaper than oral vancomycin). There is also concern that use of oral vancomycin will drive emergence of vancomycin-resistant enterococci and other multidrug-resistant organisms by causing greater disruption of the intestinal microbiota, which appears to be the case in murine models but has not been demonstrated in humans [4,5].

As enhanced diagnostic testing is developed (including polymerase chain reaction [PCR] ribotyping for detection of the hypervirulent NAP1/BI/027 strain of Clostridium difficile), it should be easier to determine patients with severe or hypervirulent disease. In the absence of this testing, however, clinical presentation and laboratory parameters including white blood cell count > 15 x 103/mm3, albumin < 2.5 g/dL, and/or serum creatinine ≥1.5 times baseline drive decisions regarding disease severity.

A recent Veterans Affairs (VA) study of more than 10,000 patients with CDI found that patients who received oral vancomycin had a lower risk of mortality across all severities of illness [6]. The authors note this difference was largely driven by patients with severe disease, where patients were approximately 20% less likely to die of any cause within 30 days if they were treated with vancomycin over metronidazole. There were no differences in mortality found in patients with mild-to-moderate disease or in CDI recurrence between treatment options irrespective of disease severity. These findings corroborate previous studies, which demonstrated superiority of vancomycin for clinical cure in severe disease. While not statistically significant, a numerically greater percentage of patients achieved clinical success with vancomycin and a lower percentage of patients experienced disease recurrence versus those treated with metronidazole, regardless of disease severity [7,8].

In the aforementioned VA study conducted by Stevens and colleagues, 42% of patients presented with severe disease, yet only 4% to 6% received initial vancomycin therapy [6]. Hopefully, antimicrobial susceptibility testing and ribotyping will become more widely available to help clinicians tailor CDI therapy to the infective strain. Until then, pharmacists can ensure that patients with severe disease or disease recurrence (regardless of severity at the time of recurrence) receive oral vancomycin therapy to enhance the likelihood of clinical success and to attenuate the chance of additional recurrence. It may be reasonable to start patients with mild-to-moderate disease and experiencing their first CDI on metronidazole, but they should be monitored closely and switched to oral vancomycin if they do not have adequate response to therapy.

2. Forget about fluoroquinolones

It is no secret that the number one risk factor for developing CDI is antibiotic exposure, but not all antibiotics were created equally when it comes to this risk. Fluoroquinolones have the highest odds ratio of CDI (2-12.7), trumping cephalosporins (1.6-5.4), clindamycin (1.8-4.8) and beta lactam/beta-lactamase inhibitor combinations (1.9); although recent literature suggests that carbapenems and clindamycin are associated with more CDIs than penicillins, carbapenems, and fluoroquinolones [9,10].

Fluoroquinolone-resistant strains of Clostridium difficile are correlated with the rising prevalence and spread of the hypervirulent NAP1/BI/027 strain. A recent study conducted in England found that national infection control efforts and antimicrobial restriction led to a significant decline in incidence of CDI [11]. While clindamycin, broad-spectrum cephalosporins, and fluoroquinolones all had restrictions during the study period, the authors attribute moving the needle on CDI rates to fluoroquinolones based on genome sequencing and fluoroquinolone susceptibility patterns. Commentary on this study points out the retrospective, quasi-experimental study design and states results should be interpreted cautiously. As mentioned above in regard to choosing appropriate empiric therapy for CDI, the author writes how molecular typing and susceptibility testing are crucial for providers to truly understand CDI and enable us to implement antimicrobial stewardship interventions that will make an impact.

When you combine the CDI data with recent FDA warnings about fluoroquinolone safety and the impact fluoroquinolone overuse has on organism nonsusceptibility (also known as antibiotic “collateral damage”), it is reasonable to avoid fluoroquinolones whenever possible when selecting antibiotic therapy. My institution piloted a fluoroquinolone restriction in our MICU, SICU and abdominal solid organ transplant units last summer and expanded this initiative housewide last month. It can be done!

First, as good antibiotic stewards we should ensure patients receive antibiotics only when they have a true infection (we won’t even talk about asymptomatic bacteriuria). After the patient is deemed clinically infected, it is our responsibility to ensure the right drug is administered at the right dosage for the right duration. Limiting days of therapy to the shortest appropriate duration is crucial to limiting antibiotic exposure and improving patient outcomes. Cumulative antibiotic exposure is particularly hazardous for CDI risk, and this risk can persist for up to 6 months after exposure to any antibiotic [12]! Have I mentioned yet how important antimicrobial stewardship is?

For example, consider a patient with a pneumonia diagnosis. It is a fairly common occurrence for patients to receive approximately 72 hours of vancomycin and piperacillin-tazobactam empiric therapy, and then be prescribed an additional 7-10 days of definitive therapy. Healthcare teams forget that the days of vancomycin and piperacillin-tazobactam count and with clinical improvement most patients should not require more than 7 days of total antibiotic therapy for this infection. Defining day 1 of therapy will vary based on the patient’s clinical status, culture data, and source control. Having the conversation early and often with providers, though, can help the entire team come to an agreement on day 1 and think about defining duration. Pro tip: If you are working on a Thursday or Friday and an antibiotic course is near anticipated completion, ask for those stop dates early to avoid the antibiotics carrying through the weekend. Those extra couple of days or doses do make a difference!

The world would be simpler if this were just an inpatient issue. Community-acquired CDI is just as serious as hospital-acquired CDI, and prevalence in the community is rising. Pharmacists can review discharge prescriptions from inpatient settings or the emergency department at the point of discharge, or once the patient arrives at a community pharmacy. If the duration or quantity seems excessive, it probably is. Do not hesitate to contact providers and ask for clarification on treatment duration to help limit antibiotic exposure and decrease the risk of CDI!

4. Ask why when it comes to the PPI

Antibiotic use is the most prominent risk factor for CDI, but other medication classes should also be watched vigilantly. Acid suppressive therapy (including proton pump inhibitors [PPI] and H2-receptor antagonists [H2RA]), has been associated with primary CDI [13]. Gastric acid protects humans by inhibiting bacterial overgrowth and preserving the normal microbiota of the gastrointestinal tract. While there is conflicting literature historically, more recent literature supports how decreased gastric acidity due to PPI therapy predisposes patients to CDI.

Kwok and colleagues found a significant association between PPI use and risk of developing CDI versus non-users in a pooled analysis of 39 studies (OR 1.74, 95% CI 1.47-2.85) [14]. The risk was increased when PPIs were combined with antibiotic therapy (OR 1.96, 95% CI 1.03-3.70). PPI use alone was associated with recurrent CDI (OR 2.51, 95% CI 1.16-5.44). This group found that H2RA use was associated with a lower risk of CDI than PPI use (OR 0.71, 95% CI 0.53-0.97). While it has also been reported that PPI use does not increase risk of CDI recurrence, more recent literature suggests recurrence does occur more frequently in patients on PPI therapy (OR 1.66, 95% CI 1.18-2.34) [15,16]. When this group evaluated all acid suppressive therapy (PPI and H2RA), there was not a significant association with recurrent CDI, implying the degree of acid suppression does make a difference in terms of overall infection risk. Extended duration of PPI therapy has also been associated with an increased risk of developing CDI [17].

Pharmacists should strongly encourage PPI cessation in patients on antimicrobial therapy, especially if the patient has a history of CDI. If the patient requires acid-suppressive for a valid indication (e.g., mechanical ventilation, severe coagulopathy, recent gastrointestinal bleed), then pharmacists can facilitate switching PPIs to H2RA’s when appropriate. The risks and benefits of acid-suppressive therapy should also be critically evaluated in patients with additional risk factors for CDI including age greater than 65, immunocompromised, serious illness, long length of stay, or previous gastrointestinal surgery or manipulation.

Pharmacists can help the health care team and patient tremendously by investigating why patients are on acid suppressive therapy and discuss stopping these medications with the patients and providers, if indicated. Multiple studies have indicated that more then 50% of patients on PPI’s do not have an evidence-based indication for therapy, meaning there is a lot of room for intervention and optimization with these medications [18.19]. One place to start is by reconciling orders from patients as they transition to the floor from the ICU; if their risk for stress ulcers has resolved and they were not on an acid suppressive agent at home, recommend discontinuation prior to transfer.

5. Drugs can cause diarrhea [20,21]

Finally, in a world where CDI is such a significant player in the hospital setting, it is important for providers to step back and consider hospitalized patients may have a cause of diarrhea that is not CDI.

The differential diagnosis for diarrhea is sometimes overlooked due to fear of CDI, and diagnostic testing is sent without ruling out other possible causes. The PCR testing for CDI is exquisitely sensitive, meaning it will result positive for nearly all Clostridium difficile, including colonization. Therefore, it is possible for a patient with a positive PCR to receive unnecessary treatment for colonization and be at risk for undertreatment of the true cause of his or her diarrhea. If a patient is complaining of diarrhea or multiple loose bowel movements, pharmacists have a great opportunity to evaluate the necessity of some medications. Streamline bowel regimens by discontinuing multiple agents and recommend transition from scheduled to as needed laxatives when appropriate.

Pharmacists can educate health care teams about medication-related causes of diarrhea. More than 700 drugs have diarrhea listed as an adverse reaction, but there are a few medications in particular that are very likely to cause diarrhea. The ones I commit to memory include:

To combat such a deadly and prevalent infection, all healthcare workers need to work together, not just infectious diseases specialists. With these quick and easy medication-related tips, pharmacists can help connect antimicrobial stewardship, infection control, primary medical teams, infectious diseases consult services, and the patient together to optimize diagnosis and treatment of CDI.

National Volunteer Week, April 23 – 29th

The C Diff Foundation celebrates National Volunteer Week, April 23 – 29 to recognize more than 150 members of the C Diff Foundation Volunteer Members, including Volunteer Patient Advocates, have collectively donated more than 20,000 hours of volunteer service to the Foundation last year. The theme for this year’s celebration is “Sharing Time, Touching Lives.”

“Through the years the C Diff Foundation Volunteer Members have served as ambassadors of goodwill, service and compassion,” said Angelo Ortiz, C Diff Foundation’s Treasurer and Chairperson of the Volunteer Patient Advocate Program

The C Diff Foundation, a 501(c) (3) non-profit organization, established in 2012, and comprised of 100% volunteering professionals dedicated at supporting public health through education and advocating for C. difficile infection (CDI) prevention, treatments, environmental safety, and support worldwide

Not only do the volunteer members provide financial support for the C Diff Foundation’s programs — it is through their dedication and passion that continuously expands the Foundation’s mission. Some volunteer patient advocates have their own unique C. diff. Survivor Journey which is shared with compassion, dedication, and caring hearts touching patients, students, fellow healthcare professionals, and residents in the community every day.

“We are fortunate to have such kind and giving volunteers,” said Nancy C. Caralla, Foundress and Executive Director of the C Diff Foundation, “It is an honor to recognize those who have selflessly given so much to help educate, and promote the Foundation’s mission worldwide.”

The C Diff Foundation Volunteer Program was organized in 2012 to provide volunteer services, promote community understanding of Clostridium difficile (C. diff.) CDI Infection Prevention, Treatments, Environmental Safety and Support and to raise funds for special C Diff Foundation patient/family programs.

The C Diff Foundation Members, with the Volunteer Patient Advocates, successfully promote
“C. diff. Awareness” nationwide and in fifty-six (56) countries and host a
U.S. Nationwide information Hot-Line (1-844-FOR-CDIF) to support health care providers, patients, and families guiding them through the difficulties caused by a C. diff. infection.

Volunteers Members serve in 12 different committees; Volunteers host monthly teleconference support sessions; Provide Education about C. diff. infection and other linked healthcare topics through workshops, community events, and literature with patients, their families, and residents from villages to cities around the globe; Triage Nurses assist patients, families, clinicians with answers to prevention, treatment, environmental safety and support questions Monday – Friday 9:00 a.m. – 5:00 p.m. EST; Register support session participants,; Provide IT management; Give clerical and social media assistance to various departments; Provide a “Global Broadcasting Network” with www.cdiffradio.com with their educational radio
program,C. diff. Spores and More which broadcasts live every Tuesday at 1:00 p.m. EST. We are grateful for our sponsor Clorox Healthcare for making this program possible. Each episode becomes a podcast and is accessible from the C. diff. Spores and More living library located on the main cdiffradio.com program page. Each Novemberthe Volunteer Members gather at the annual conference to both present and provide assistance in making the attendees feel welcome and expand their knowledge base on a variety of health topics that are linked to the main topic ~ Clostridium difficile infections.

TOMI Environmental Solutions, Inc. (“TOMI”) a global decontamination and infection prevention company that specializes in disinfection/decontamination sales and services, including the manufacturing, sale and licensing of its SteraMist™, a hydrogen peroxide-based mist/fog that is registered with the U.S. Environmental Protection Agency (“EPA”), announced the publication of a peer reviewed paper titled “Use of Novel Approaches to Reduce Clostridium Difficile in an Inner City Hospital,” which concluded that the use of TOMI’s SteraMist™ BIT™ contributed to the substantial reduction in a Wilmington, Delaware hospital’s Clostridium Difficile (C. Diff) burden. The paper was written by Dr. Helene Paxton, MS, MT (ASCP), PhD, CIC, Infection Preventionist, Bio Guidance, LLC and member of TOMI’s Science Advisory Board, and outlines the incorporation of SteraMist™ BIT™ into everyday disinfection protocols of a healthcare facility. This paper was peer reviewed by Dr. Uyen Nguyen.

“In the healthcare space, TOMI has been making strides to continuously demonstrate the efficacy of SteraMist™ in combating and reducing hospital infections,” said Dr. Halden Shane, CEO and Chairman of TOMI Environmental Solutions, Inc. “This further review and publication of the efficacy of TOMI’s SteraMist™ is an important verification in our battle to address the increase in C. diff infections, which lead to thousands of deaths in the U.S. each year.”

To read this article in its entirety please click on the following link:

Nearly 300 people die in the U.S. every day from an infection they acquired during their hospital stay, and the death toll is even higher internationally. Healthcare Associated Infections (HAIs),including Methicillin-resistant Staphylococcus aureus (MRSA), are becoming an international crisis. Bacterial spores such as C. diff have become an even larger problem in hospitals and in their respective communities, and it is estimated that nearly half a million Americans contract C. diff every year.

TOMI’s EPA registered BIT™ (Binary Ionization Technology®), branded as SteraMist™, converts a low percentage hydrogen peroxide into a hydroxyl radical by passing the liquid through an atmospheric cold plasma arc, a technology initially developed under the sponsorship of the Defense Advanced Research Projects Agency (DARPA) of the U.S. Department of Defense. SteraMist™ BIT™ quickly destroys deadly viruses, bacteria and spores before they pose a threat to patients, healthcare workers and their communities.

TOMI’s SteraMist™ helps hospitals reduce their HAI rates by destroying the microscopic germs that may be missed during the manual cleaning process. TOMI’s germ fighting technology uses an environmentally-friendly process, the only by-product of which is oxygen and humidity. The SteraMist™ aerosol quickly destroys infectious germs in less than five seconds. Hospitals using SteraMist™ devices have reported and published outcomes in papers and in a peer-reviewed journal showing significant decreases in C. diff rooms after the use of SteraMist.

Dr. Shane further stated: “Hospitals can and should do more to keep patients safe. No one wants a loved one to go to the hospital and contract C. diff or any hospital acquired infection. Hospitals routinely using SteraMist™ have repeatedly demonstrated lower infection rates, which leads to enhanced patient and employee safety. Hospitals using our technology can stop the spread of infections while improving their bottom line.”

Uniquely designed for ease of use and portability, a hospital’s environmental services staff can operate SteraMist™ quickly without disrupting hospital operations. With a five second exposure time, the surface unit can disinfect a hospital room’s high touch surfaces and delicate medical equipment in less than 10 minutes. SteraMist™ is designed to go in, above, beyond, under and around objects in patient rooms, operating rooms, equipment rooms, emergency rooms, intensive care units and public areas. SteraMist™ does not damage medical equipment. Many hospitals in the U.S., Europe, West Africa, Central America and Asia have used SteraMist™ in their decontamination protocols. SteraMist™is also used in skilled nursing facilities, ambulatory surgery centers, long term acute care facilities and childcare facilities.

About TOMI Environmental Solutions, Inc.

TOMI Environmental Solutions, Inc. (OTCQX:TOMZ) is a global decontamination and infection prevention company, providing eco-friendly environmental solutions for indoor surface disinfection through manufacturing, sales and licensing of its premier Binary Ionization Technology® (BIT™) platform, which was invented under a defense grant in association with the Defense Advanced Research Projects Agency (DARPA) of the U.S. Department of Defense. BIT™ uses a low percentage Hydrogen Peroxide as its only active ingredient to produce a hydroxyl radical (OH ion) and is represented by the TOMI™ SteraMist™ brand of products, which produce a germ-killing aerosol that behaves like a gas.

TOMI’s products are designed to service a broad spectrum of commercial structures including hospitals and medical facilities, cruise ships, office buildings, hotel and motel rooms, schools, restaurants, for non-food safety in meat and produce processing facilities, military barracks, and athletic facilities. TOMI’s products and services have also been used in single-family homes and multi-unit residences.

TOMI also develops training programs and application protocols for its clients and is a member in good standing of The American Biological Safety Association, The American Association of Tissue Banks, Association for Professionals in Infection Control and Epidemiology, Society for Healthcare Epidemiology of America and The Restoration Industry Association. For additional information, visit www.tomimist.com or contact us at info@tomimist.com.

Cautionary Statement Regarding Forward Looking Statements

Certain written and oral statements made by us may constitute “forward-looking statements” as defined in the Private Securities Litigation Reform Act of 1995 (the “Reform Act”). Forward-looking statements are identified by such words and phrases as “we expect,” “expected to,” “estimates,” “estimated,” “current outlook,” “we look forward to,” “would equate to,” “projects,” “projections,” “projected to be,” “anticipates,” “anticipated,” “we believe,” “could be,” and other similar phrases. All statements addressing operating performance, events, or developments that we expect or anticipate will occur in the future, including statements relating to revenue growth, earnings, earnings-per-share growth, or similar projections, are forward-looking statements within the meaning of the Reform Act. They are forward-looking, and they should be evaluated in light of important risk factors that could cause our actual results to differ materially from our anticipated results. The information provided in this document is based upon the facts and circumstances known at this time. We undertake no obligation to update these forward-looking statements after the date of this release.

The C Diff Foundation’s organization is comprised of 100% volunteering members who are dedicated to our mission and adhere to the Foundation’s Code of Ethics

which prohibits the endorsement and promotion of products, services, medications, or clinical studies in progress.

All website entries, public presentations, and workshops are to raise C. diff. infection awareness in all areas of the C Diff Foundation’s mission statement, including infection prevention, sepsis, healthcare-associated infections, antimicrobial resistance, antibiotic stewardship and provide education on all the above.”

Accomplished by using short-wave
ultraviolet-C (UV-C) light as a germicidal to destroy viruses, bacteria and other pathogens that can linger on surfaces and hide in shadows.

One piece of equipmnet can disinfect an average-sized patient room in about 8 minutes and is deployed after a room is sanitized with standard techniques and cleaning products.

In Canandaigua, New York a nearly 6 foot tall and wielding 20 vertical fluorescent bulbs, the R-D Rapid Disinfector robot is a formidable fighter in the war against germs.

This UV disinfecting robot is The R-D Rapid Disinfector — developed by a Rochester, New York firm, Steriliz LLC, and is manufactured locally.

Thompson Hospital and the M.M. Ewing Continuing Care Center have begun using this automated disinfecting machine throughout the institutions to help reduce the risks of illness and infections for patients, residents, visitors and staff.

The Disinfector uses short-wave ultraviolet-C (UV-C) light as a germicidal to destroy viruses, bacteria and other pathogens that can linger on surfaces and hide in shadows. This machine can disinfect an average-sized patient room in about 8 minutes and is deployed after a room is sanitized with standard techniques. It is remotely controlled by an associate from Environmental Services.

The UV-C light fills the entire room, reaching and disinfecting areas that human hands might miss. No one is allowed inside the room when the lights are working. This no-touch cleaning system gets rid of some of the most dangerous and difficult-to-destroy bacteria, including Clostridium difficile (C. diff). Disinfectants work on the surface of non-living objects by destroying the cell wall of harmful microbes or interfering with their metabolism.

“This technology, added on to normal, regular, manual environmental cleaning, gives me a sense of ease that we are doing all we can to keep our environment clean and our patients safe,” said Thompson Health Director of Infection Prevention Michelle Vignari. “We are just now starting to see published literature supporting that the addition of UV-C technology in hospitals actually does correlate with a reduction of healthcare-acquired infections.”

This state-of-the-art robot monitors the entire disinfection process. Wireless sensors measure, record and report on UV-C light dosages delivered to specific areas in real time. The machine can be paused and repositioned to maximize efficiency, including targeting shadowed areas. The Disinfector shuts off automatically once the sensors indicate that enough UV-C light has been emitted to kill the germs.

“In a day of delivering high-reliability care, I felt very strongly that we needed a technology that we could measure and evaluate its performance,” Vignari said.

Hospital staff like the Disinfector too.

“It is pretty simple to use and seems to be working great,” said Stephanie Fowler of Environmental Services, who activates the robot after a room is cleaned with traditional methods.

The R-D Rapid Disinfector was developed by a Rochester firm, Steriliz LLC, and is manufactured locally. The Disinfector uniquely provides FDA-patented wireless sensors to measure the amount of UV-C light delivered to an area and real-time online data access and reports. Since being tried in four Rochester hospitals in 2011, several hundred of these Disinfectors are now being used in hospitals, care homes, disaster centers and government installations worldwide.

Steriliz is recognized as a world leader in UV-C disinfection.

“Improving the health and safety of patients is a blessed opportunity,” said CEO and President Sam Trapani. “The potential market for the company’s product is large and we are experiencing a high growth curve.”

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